A report by iVantage Health Analytics found Ohio metro hospitals are barely in the black, while rural facilities showed narrow losses. Hospitals in Washington Court House and Logan have closed maternity units. Hospitals in Chillicothe and Zanesville had their bond ratings downgraded. Hospital workers in Gallipolis (gahl'-ih-poh-LIHS') face possible layoffs, while OhioHealth is closing its inpatient hospital in Nelsonville. The Affordable Care Act has begun to address the costs of the uninsured and could also cut into charity-care costs, particularly in states that have expanded Medicaid like Ohio.